Facet Joint Blocks
There are many causes of low back pain and sciatica which are largely poorly understood.
The facet joints are the articulating surfaces between the vertebrae of the spine.
Degenerative change and inflammatory conditions of the facet joints can produce
pain in the back, buttocks and outer sides of the thighs. It is possible
to irritate the nerve that passes immediately in front of the facet joint producing
symptoms very much like sciatica, which is pain down the leg on the same side
as the facet joint which is causing the problem.
The typical symptoms of facet joint syndrome includes pain associated with stiffness
in the morning and after prolonged immobility such as sitting or standing for
long periods. This is essentially due to the fact that the 'WD40'
between the joint surfaces dries out from being held in one position for a prolonged
period allowing the joints to weld themselves together. The first few movements
afterwards are therefore very difficult until the joints starts to warm up and
lubricate themselves again.
If investigations and the history suggests that much of the pain is coming from
facet joints, then these joints can be injected in order to improve the patient's
comfort allowing the patient to become more mobile and hopefully to gain strength,
flexibility and confidence.
The facet joints are deep within the body wall and therefore an injection into
and around these joints is done under x-ray control to allow accurate needle placement.
The procedure is done under sedation so that there is no discomfort for the patient.
The injection is an anti-inflammatory agent of a hydrocortisone and a local anaesthetic.
The hydrocortisone does not have any effect elsewhere in your body as it is not
injected into the circulation. It has a local effect on the target area,
reducing the inflammation within it. The local anaesthetic is to keep the
area numb for a period of some hours for the patient's comfort.
After the injections have been carried out, the patient will be sedated and will
rest on the ward. After recovery the patient will be allowed to have something
to eat and drink and be discharged once their condition allows.